Gareth S. Owen, PhD, MRCPsych, Department of Psychological Medicine, King's College London, Institute of Psychiatry, London, UK; George Szmukler, FRCPsych, Department of Health Service and Population Research, King's College London, Institute of Psychiatry, London, UK; Genevra Richardson, LLM FBA, School of Law, King's College London, UK; Anthony S. David, FRCPsych, Department of Psychological Medicine, King's College London, Institute of Psychiatry, London, UK; Vanessa Raymont, MRCPsych, Centre for Mental Health, Department of Medicine, Imperial College, London, UK, and Department of Radiology, Johns Hopkins University, USA; Fabian Freyenhagen, PhD, Wayne Martin, PhD, School of Philosophy and Art History, University of Essex, Wivenhoe Park, Essex, UK; Matthew Hotopf, PhD, MRCPsych, Department of Psychological Medicine, King's College London, Institute of Psychiatry, London, UK.
Br J Psychiatry. 2013 Dec;203(6):461-7. doi: 10.1192/bjp.bp.112.123976. Epub 2013 Aug 22.
Is the nature of decision-making capacity (DMC) for treatment significantly different in medical and psychiatric patients?
To compare the abilities relevant to DMC for treatment in medical and psychiatric patients who are able to communicate a treatment choice.
A secondary analysis of two cross-sectional studies of consecutive admissions: 125 to a psychiatric hospital and 164 to a medical hospital. The MacArthur Competence Assessment Tool - Treatment and a clinical interview were used to assess decision-making abilities (understanding, appreciating and reasoning) and judgements of DMC. We limited analysis to patients able to express a choice about treatment and stratified the analysis by low and high understanding ability.
Most people scoring low on understanding were judged to lack DMC and there was no difference by hospital (P = 0.14). In both hospitals there were patients who were able to understand yet lacked DMC (39% psychiatric v. 13% medical in-patients, P<0.001). Appreciation was a better 'test' of DMC in the psychiatric hospital (where psychotic and severe affective disorders predominated) (P<0.001), whereas reasoning was a better test of DMC in the medical hospital (where cognitive impairment was common) (P = 0.02).
Among those with good understanding, the appreciation ability had more salience to DMC for treatment in a psychiatric setting and the reasoning ability had more salience in a medical setting.
治疗决策能力（DMC）在医学和精神科患者中的性质是否存在显著差异？
比较能够沟通治疗选择的医学和精神科患者的 DMC 相关能力。
对两个连续入院的横断面研究（125 例精神病院和 164 例内科）进行二次分析。使用麦克阿瑟能力评估工具-治疗和临床访谈来评估决策能力（理解、评估和推理）和 DMC 判断。我们将分析仅限于能够表达对治疗选择的患者，并按理解能力高低进行分层分析。
大多数理解能力得分低的人被判断为缺乏 DMC，且不同医院之间无差异（P = 0.14）。在两个医院中，都有能够理解但缺乏 DMC 的患者（精神科住院患者中为 39%，内科住院患者中为 13%，P<0.001）。在以精神病和严重情感障碍为主的精神病院，评估更能反映 DMC 的是理解（P<0.001），而在以认知障碍常见的内科医院，评估更能反映 DMC 的是推理（P = 0.02）。
在理解能力较好的患者中，在精神病治疗中，评估更能反映 DMC 的是欣赏能力，而在医学治疗中，评估更能反映 DMC 的是推理能力。
